de Groot Bas, Verdoorn Ruben C W, Lameijer Joost, van der Velden Jolanda
SEH, Leiden University Medical Centre, Leiden, Zuid Holland, The Netherlands.
Vrije Universiteit Medical Centre, Amsterdam, The Netherlands.
Emerg Med J. 2014 Nov;31(11):882-8. doi: 10.1136/emermed-2013-202865. Epub 2013 Aug 21.
To assess the prognostic and discriminative accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for prediction of inhospital mortality in emergency department (ED) patients with suspected infection.
Prospective observational derivation study in ED patients with suspected infection. Prognostic performance of hs-cTnT (divided in four quartiles because of non-linearity) for prediction of inhospital mortality was assessed using multivariable logistic regression, correcting for predisposition, infection, response and organ failure (PIRO) score as a measure of illness severity and quality of ED treatment as quantified by the number of 'Surviving Sepsis Campaign' goals achieved. Discriminative power of hs-cTnT was assessed by receiver operator characteristics with area under the curve (AUC) analysis.
Hs-cTnT (median (IQR) was 57 (25-90) ng/L (n=23) in non-survivors, significantly higher than the 15 (7-28) ng/L in survivors (n=269, p<0.001). Additionally, the lowest quartile of hs-cTnT was a perfect predictor of survival because zero death occurred. Therefore, the second quartile was used as a reference category in the multivariable logistic regression analysis showing that hs-cTnT was an independent predictor of inhospital mortality: Corrected ORs were 2.2 (95% CI 0.4 to 12.1) and 5.8 (1.2 to 27.3) for the 3rd and 4th quartile compared with the 2nd hs-cTnT quartile. The AUCs of hs-TnT was 0.81 (0.74 to 0.88), similar to the AUC of 0.78 (0.68 to 0.87) of the PIRO score (p>0.05). Overall negative predictive value of hs-cTnT was 99%.
In ED patients with suspected infection, the routinely used biomarker hs-cTnT is an independent predictor of inhospital mortality with excellent discriminative performance. Future studies should focus on the additional value of hs-cTnT to existing risk stratification tools.
评估高敏心肌肌钙蛋白T（hs-cTnT）对预测急诊科（ED）疑似感染患者院内死亡率的预后及判别准确性。
对ED疑似感染患者进行前瞻性观察性推导研究。使用多变量逻辑回归评估hs-cTnT（因非线性分为四个四分位数）预测院内死亡率的预后性能，校正易感性、感染、反应和器官功能衰竭（PIRO）评分作为疾病严重程度的指标，并将实现的“拯救脓毒症运动”目标数量作为ED治疗质量的量化指标。通过曲线下面积（AUC）分析的受试者工作特征曲线评估hs-cTnT的判别能力。
非幸存者的hs-cTnT中位数（IQR）为57（25-90）ng/L（n = 23），显著高于幸存者的15（7-28）ng/L（n = 269，p<0.001）。此外，hs-cTnT的最低四分位数是生存的完美预测指标，因为无死亡发生。因此，在多变量逻辑回归分析中，将第二四分位数用作参考类别，结果显示hs-cTnT是院内死亡率的独立预测指标：与hs-cTnT第二四分位数相比，第三和第四四分位数的校正比值比分别为2.2（95%CI 0.4至12.1）和5.8（1.2至27.3）。hs-TnT的AUC为0.81（0.74至0.88），与PIRO评分的AUC 0.78（0.68至0.87）相似（p>0.05）。hs-cTnT的总体阴性预测值为99%。
在ED疑似感染患者中，常规使用的生物标志物hs-cTnT是院内死亡率的独立预测指标，具有出色的判别性能。未来研究应关注hs-cTnT对现有风险分层工具的附加价值。
